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Home My WebLink About2006-P10287 - re-roof � PERMIT CITY JF ORONO 2750 Kelley Parkway- PO Box 66 Permit Number: p1o287 Crystal Bay, Minnesota 55323 Permit Type: Minor Alterations (952) 249-4600 Date Issued: 9/5/2006 SITE ADDRESS: 20 Cygnet Pl Unit# Long Lake, MN 55356 P I D: 04-117-2 3-22-0024 DESCRIPTION: Proposed Use: Residential Census Code O/S-Building Permit Class: Building Permit Type: Minor Alterarions Permit Sub-type(s): Building-Re-Roof DETAILS: Approved per resolution#: Separate permits required: NOTICES/REMARKS: FEE SUMMARY: Pernut Fee: $ 181.25 valuation: $ 9,500.00 State Surcharge Fee: $ 4.75 TOTAL FEE: $ 186.00 APPLICANT: Plymouth Roofing&Insulation OWNER: Harold&Margaret Panuska 17525 Cty Road 24 20 Cygnet Pl Plymouth,MN 55447 Long Lake MN 55356 THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF MINNESOTA BUILDING CODE REQUIREMENTS. � � � PLIC ' MI E SIGNATURE ISSUED BY SIGNATURE Copies: 1-File(Signata�res Reguired), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page ] Total Fee: $ l 0 (9• � DateReceived: 9 -,S-�Cp Entered By: , Permit#: i°/UZ�7 CITY OF ORONO - BUILDING PERMIT APPLICATION All information must be submitted in full before plan review will be started. (please p��i�7t all informatio��) ------------------------------------------------------------------------------------------------------------------------ THE APPLICANT IS: (circle a�e) OWNER OR CONTRACTOR JOB SITE ADDRESS: cx�C��/l3� I }�LI�F �G��( L�l�= ZIP: �`7�J� t4 Will this be a Parade of Homes, Remodelers Sho�vcase Home or other Display Home? ❑ Yes � No If yes, a specia/event per•mil ls r•egirir•ed tivrth Police Department ar�d City Cot�ncil approval 60 days prior to the evef�t. Shi�ttle bzis servrce will be re�crir•ed arnless applicant dei��onstr•crtes sz ff cient oi�-srte parking is available. IVon-permitled evenls i-vill not be allowed. NAME OF OWNER: �k'N P�LI� r�"�I,I.S�A PHONE: (home)��-r3-��f��dU p (work) MAILING ADDRESS: ��Cy�;/u�:T 1 L�� CITY: �E-r'1�•��£_ ZIP: ��35 • CONTRACTOR: ��.�I��VI,T� I�OO FI I�� PHONE: 7��'�73�-� 3� 7 CONTACT PERSON: ��Q_,(,� MOBILE/PAGER: �;(��- � �,$ ••�3��% MAILING ADDRESS: � 1��5 (;'I-y t�,Cj �1 f CITY: P��vr��u,t�-, ZIP: �� STATE LICENSE: # �3�� EXPIRATION DATE: � i �7 ARCHITECT/ENGINEER: PHONE: MAILING ADDRESS: CITY: ZIP: NAME: REGISTRATION: # TYPE OF WORK: New Home Addition Accessory Structure Move Home Remodel/Alteration (ie: Siding, Windows) Any earth movement may require MCWD review and permits ! . PROPOSED WORK(describe in detai�I`�"�f}�-D��f� E�r1C��y�� f ��vs��f� -��'rr ►.:�w�{�.t:�ta.u,�ys:��o�e:T�JsTt�� sr.l��c�si.1 F�b�tY�(c,sS Ar�ki-��s#u,��sh��lt-T 's_ STORIES: SQ.FEET OF EACH FLOOR: NO. OF BEDROOMS: GARAGE STALLS: ATTAC�I�D DETACHED � ESTIMATED CONSTRUCTION VALUATION(excluding land): $ � �� I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in confonnance with the ordinances and codes of the City and with the State Building Code;that I �mderstand this is not a permit and��ork is not to sta�.t without permit;and that the work will be in accordance with the approved pla ,., .�� s AYPLICANT'SSIGNATUKE ATE: �`� °'��Q� 31 Scc.13.0�1 RIGHTS OF SUBJECTS OF DATA Subd. 1. Type of data. The rights of individuaf on�ahom d�e data is stored or to be stored shall be as set forth in this section. Subd.2. [nfonnation required to be given individual. An individual asked[o supply private or contidential data concerning himselfshall be informed of (a)tlle purpose and intended use ofthe requested data�vithin the collecting state agency,political subdivision,or statewide syscem;(b) whetlier he may refuse or is legally required to supply the requested data,(c)any known consequence arising from his supplying or refusing to supply private or confidential data;and(d)the identity of other persons or entities authorized by state or tiederal law to receive the data. This requirement shall not apply when an individual is asked to supply investigative data,pursuant to section 13.82,subdivision 5,to a law enforcement ofticer. The commissioner of mvenue may�lace the notice required under this subdivision in the individual income ta�or propertv tax refund instructions instead of on those tonns. Subd.3. Access ro data by individual. Upon request to a responsible authoriry,an individual shall bc informed whedier he is the subject of stored data on individuals,and whedier it is c(assitied as public,private or contidential. Upon his further request,an individual who is the subject of stored private or public data on individuals shall be shown tlle data without any charge to him and,if he desires,shall be informed ofthe content and meaning of that data. After an individual has been shown the private data and informed of its meaning,the data need not be disclosed to him for six months thereatter unless a dispute or action pursuant to this section is pending or additional data on the individual has been collected or created. The responsible authority shall provide copies of the private or public da[a upon request by the individual subject of the data. The responsible auchority may require d�e requesdng person to pay the actual costs of making,certitying,and compiling the copies. The responsible authority shal l comply immediately,if possible,with any request made pursuant to this subdivision,or within tive days of the date ofthe request,e�cluding Saturdays,Sundays and legal holidays,if immediate coinpliance is not possible. [f he cannot comply�vith the request within that time,he shall so inform the individual,and may have an additional frve days within which to comply�aith the request,excluding Saturdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complele. An individual may contest the accuracy or comple[eness of public or private data conceming himself. To exercise this ri�ht,an individuai shall notify in writing the responsible authority describing the nature ofthe disagreement. The responsible authority shall��ithin 30 days either. (a)correct the data found to be inaccurate or incomplete and attempt[o notify past recipients of inaccurate or incomplete data,induding recipients named by the individual;or(b)notify the individual that he believes the data to be correc[. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. The determination of the responsible authority may be appealed pursuant to the provisions of the administrative procedure act relating to contested cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04,Subd.2,"Rights of subjects ofdata",we wouid like to inform you that your request for a pennit or license from the City of Orono or any of its departments may require you to furnish certain private or confidential information. You are notified that: 1. The information you furnish will be used to determine your qualification for the permit or license requested. 2. You may refuse to supply data,but refusal may require that the City deny the permit or license. 3. The information may be shared with other local, state or federal agencies to the extent necessary to process the pernlit or(icense. 4. If your requested permit or license requires Council action to approve, some inforn�ation may become public. 5. You have certain ri�hts under Nt.S. 13.04 (available upon request)to review private data on yotirself. 6. Your fu11 name is required to �rocess this application or permit. 7� 1� Co u.rrtE�,e y �}-c�� L�.�% First �4iddlc Last 1 �� 5 i i�� A�ar�55 7� � �� , N �5 �f 7��-- 73� � � Ciiy Siate 'I_ip Phcn2 understand r�ry rig s as at�d abov". �� Signaturc Reset Form 32